On Mentoring PRACTICE MANAGEMENT

Transcription

1 American Journal of Gastroenterology ISSN C 2007 by Am. Coll. of Gastroenterology doi: /j x Published by Blackwell Publishing PRACTICE MANAGEMENT On Mentoring Douglas A. Drossman, M.D. Co-Director, UNC Center for Functional GI & Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Am J Gastroenterol 2007;102: ) As academic clinicians and investigators, it is important to facilitate the training of young investigators and clinicians so they can become knowledgeable, competent, and independent in their careers. This process of mentoring is a form of facilitative learning that has its origins extending thousands of years. It began with the oral law or the passing down of knowledge from generation to generation in many cultures such as the tribes in Africa, Native Americans, and Orthodox Judaism. This process allows for the continuation of traditional values and, with regard to the field of medicine, can preserve medical and scientific knowledge and wisdom through apprenticeship, where the protégés later become mentors to future generations. Within academic medicine, this process has become formalized through training grants from the National Institutes of Health (e.g., T32 awards), preceptorships, residencies, and fellowships. Yet, there has been limited attention to the process of mentoring. How should the mentor and mentee interact? What are the goals, benefits, and challenges of mentoring? Finally, how do we judge success? This column sets forth some suggested guidelines for trainee supervision through a mentoring relationship with a senior faculty member in a research or clinical environment. THE VALUE OF A MENTORING RELATIONSHIP Mentoring is a development-enhancing relationship between a more experienced or senior investigator and a trainee or a junior investigator. Within the academic environment, mentoring is a means to systematically assist trainees and junior faculty in their career development, usually by a single senior faculty member. However, this may also occur with more than one mentor. Mentoring is a constantly changing iterative process that leads to professional growth for both participants. The values of mentoring are displayed in Table 1. There is evidence that a mentoring relationship leads to enhanced professional development for the protégé. Studies show that mentored faculty: (a) spend more time on research, (b) rate their research skills higher, (c) are more likely to receive grant funding, (d) rate higher support for teaching research and administration, and (e) have greater career satisfaction (1). Furthermore, successful researchers are more likely to have had mentors before, during, and after their training and they maintain these relationships with their advisors throughout their career (2). The attributes of a successful mentor are displayed in Table 2. They relate not only to the provision of knowledge and resources, but also to several personal values relating to integrity, effective communication skills, and enjoyment of the work and mentoring process. In turn, the mentee must, in a similar fashion, respect and value the contribution of the mentor and work with him or her to achieve professional knowledge and skills with the expectation of assuming a mentor role in the years to come. THE MENTORING PROCESS The mentoring process can be viewed as evolving in discrete stages. Initially, the mentor takes on most of the for the protégé s learning and provides most of the resources. This can involve discussing goals and expectations, scheduling meetings, providing the agenda based on the needs of the mentee, and providing feedback. The mentor also identifies and addresses the mentee s views and facilitates the acquisition of knowledge. This can be of immediate and concrete relevance, such as helping to write an abstract, or providing articles and other educational resources, and assisting with writing grants, budgets, and presentations. Through these activities, the mentor must create a need to learn in other relevant areas (psychosocial and communication skills, biostatistics, writing skills, and creative thinking). Over time, as the relationship matures, the mentor takes more of a back seat and becomes a facilitator, encouraging the mentee s professional growth and for tasks. Table 3 breaks down the process into 5 levels, beginning with the more traditional pedantic learning (i.e., where the teacher sets the agenda for learning), and evolving through androgogic (i.e., adult learning where the agenda is set by the learner), the most developed stage being full collaboration. The time in which these levels can be achieved is determined by the parties involved, their skills and needs, and the quality of the mentoring relationship. CLINICAL MENTORING Within a clinical context, mentoring is a preceptorship, where the mentor provides the initial knowledge and guidance for 1848

2 On Mentoring 1849 Table 1. Mentoring Values Mentoring Values Protégé Mentor Career gain Work productivity Personal Interpersonal Receives expert guidance Gains knowledge and resources Gratification from expert attention, support, direction Long-term personal and professional relationship Exercises higher level of dynamic teaching Protégé extends work productivity Rejuvenation of work and enhanced self-esteem via protégé s enthusiasm Long-term personal and professional relationship clinical decision making until the protégé becomes selfsufficient and then is available as needed for consultation. While many attendings believe they need to be the ultimate purveyor of the knowledge, in modern times, this is nearly impossible. The rapid expansion of the data in medicine makes it difficult for one person to know it all. Instead, Table 2. Positive Attributes of a Mentor and Expectations of the Mentee (3) Knowledge and resources 1. Knows how to provide expertise in areas of mutual interest 2. Knows how to provide direction and guidance on professional issues (e.g., joining organizations, networking) 3. Is willing to provide resources (e.g., research assistants, source materials, statistical assistance) 4. Is connected to other resources and individuals as needed. Teaching and supervision 1. Is approachable, accessible, personable 2. Is supportive and encouraging 3. Provides positive and negative feedback 4. Possesses good communication skills (writing, speaking, interpersonal) 5. Seeks to improve the protégé s knowledge, skills, productivity 6. Promotes independence 7. Challenges protégé to extend his/her abilities 8. Employs a learner centered approach recognizes/adapts to new learning styles Personal values 1. Exhibits professional integrity 2. Achieves credibility and respect among peers 3. Communicates satisfaction with career 4. Acknowledges and facilitates protégé s contributions (e.g., authorship, awards) 5. Able to tolerate challenges from protégé without reacting personally Expectations of the mentee 1. Takes greater in setting the agenda over time 2. Seeks to initiate new ideas 3. Is respectful of mentor s time and availability 4. Communicates with mentor on concerns 5. Provides status of activities and projects 6. Accepts new challenges 7. Seeks feedback and takes to give feedback to mentor 8. Knows personal limits and when to ask for help 9. Personally reassesses goals over time 10. Doesn t overstep boundaries (e.g., overuse of time, dependency on mentor for answers) Table 3. Transitions in the Mentoring Process Over Time Mentoring Transition Stages in Relationship Level Protégé Mentor I. Pedantic learning Learns basic elements Initiates ideas Primary task Active teaching II. Tutoring Increased Supervises work Increased self-learning Frequent tutoring III. Androgogic learning (learner sets agenda) Initiates/develops ideas Primary task Tutors when needed Full for ideas and work tasks Provides feedback Negotiates ideas IV. Autonomy Feedback when needed V. Collaboration Shared Shared the mentor s job is to teach trainees how to gather the information and to facilitate the trainees ability to make decisions with the remarkable abundance of information that exists; thus it is the art of medicine that is communicated (4). One study compared the attributes of attendings selected by house staff as excellent role models to those who also taught residents but were not chosen as role models. The attributes attributed to the attending role models include: (a) spending at least one-quarter of the time on teaching (OR 5.1, 95% CI ), (b) stressing the physician patient relationship (OR 2.6, 95% CI ), (c) teaching the psychosocial aspects of medicine (OR 2.3, 95% CI ), and (d) having served as a chief resident, presumably to gain more experience as a teacher (OR 1.1, 95% CI ) (5). SURVEY OF EXPECTATIONS WITHIN A MENTORING RELATIONSHIP In a recent survey of gastroenterology fellows participating in a skills development workshop, 20 fellows and 5 faculties were surveyed regarding expectations and needs of the protégé, and the positive and negative attributes of mentors. The results, shown in descending order of responses, were as follows: Expectations of Mentor: To have positive personality attributes, accessibility and approachability, technical skill, an ability to listen and provide advice, the provision of honest feedback, and also support for the mentee s career goals. Needs of Protégé: To be coached in career development and technical skills, to be given honest feedback, and to be stimulated toward developing new ideas.

3 1850 Drossman Positive Qualities of a Mentor: To demonstrate leadership and to serve as a role model, to possess positive personality attributes, energy and enthusiasm, and a facilitative style, and to be approachable and knowledgeable. Negative Qualities of a Mentor: To be frequently unavailable, to assert a dominant or self-serving teaching style, and to be a poor communicator. PROVIDING FEEDBACK Feedback relating to the mentoring process is a mutual process. In addition to the mentor providing constructive feedback to the protégé, it is equally important for the mentor to also be apprised of his or her strengths and weaknesses. One example of an evaluation instrument used at the University of North Carolina Center for Functional GI and Motility Disorders is shown in the appendix. The form is designed to parallel both the mentor and mentee s observations. It can be reviewed and updated, usually about twice a year. Through the use of such feedback the mentoring process can not only serve to help grow academicians and clinicians, but it can also become one of the more gratifying experiences for mentor and protégé alike. Reprint requests and correspondence: Douglas A. Drossman, M.D., CB 7080, 4150 Bioinformatics Bldg, Chapel Hill, NC REFERENCES 1. Rose GL, Rukstalis MR, Schuckit MA. Informal mentoring between faculty and medical students. Acad Med 2005;80: Palepu A, Friedman RH, Barnett RC, et al. Junior faculty members mentoring relationships and their professional development in U.S. medical schools. Acad Med 1998;73: Berk RA, Berg J, Mortimer R, et al. Measuring the effectiveness of faculty mentoring relationships. Acad Med 2005;80: Greganti MA, Drossman DA, Rogers JF. The role of the attending physician. Arch Intern Med 1982;142: Wright SM, Kern DE, Kolodner K, et al. Attributes of excellent attending-physician role models. N Engl J Med 1998;339: Mentoring Assessment

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